Contrôles externes T2A ou l’inlassable suspicion de fraude (2nde partie)
Animée par une volonté tenace de résorber le déficit de l’Assurance Maladie, la Caisse Nationale de l’Assurance Maladie des travailleurs Salariés (CNAMTS) a développé depuis 2005, année de création de sa Direction du contrôle contentieux, une sémantique belliqueuse dans sa lutte contre les irrégularités commises, au cas présent, par les établissements de santé.
L’État participe également à ce mouvement de durcissement. En effet, la Direction Générale de l’Offre de Soins (DGOS) projette depuis plusieurs mois de publier un décret ((Un courrier de protestation et d’alerte daté du 12 février 2010 a été adressé à la Directrice de la DGOS par l’ensemble des fédérations hospitalières (FHF, FHP, FHP-MCO, FEHAP, FNLCC et FNEHAD) mais il est resté sans réponse…)) :
- qui modifierait l’article R.162-42-12 du code de la sécurité sociale en ce que l’assiette de calcul des sanctions ne porterait plus sur les recettes annuelles afférentes aux activités contrôlées mais sur la totalité des recettes d’Assurance Maladie de l’établissement,
- et qui introduirait la possibilité de contrôler désormais un établissement sur une année différente de celle de l’année antérieure au contrôle.
Lire la suite ici (ou bien dans la revue Finances Hospitalières).
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